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Biomedical subjects

R B Hackey

Publications and source records attributed to R B Hackey.

7 recordsLinked to original sources
PubMed1996

Setting limits through global budgeting: hospital cost containment in Rhode Island.

In 1974, hospitals in Rhode Island have participated in annual negotiations with state officials and representatives from Blue Cross to determine the allowed increase in statewide hospital costs (the "Maxicap") for the next fiscal year, based on projected increases in hospitals' revenues, changes in patient volume and operating expenses. Individual hospital budgets may be above or below the Maxicap as long as the total increase in hospital costs for all hospitals in the state does not exceed the negotiated amount. At a time when regulatory solutions are increasingly under fire, continued support for Rhode Island's approach to hospital cost containment from third party payers, providers and public officials stands in stark contrast to other states where rate setting was either dismantled or discredited as a cost control strategy. A negotiated global cap on hospital expenditures offers an alternative to formula-based state rate-setting methodologies which could be incorporated as part of an all-payer reimbursement methodology or as an incremental step towards more comprehensive reform.

Blue Cross Blue Shield Insurance Plans↗
PubMed1995

The politics of trauma system development.

Federal and state policymakers have turned to health planning programs as a means to rationalize the delivery of health care services in the United States for over 3 decades. Early federal initiatives such as the Comprehensive Health Planning Act of 1966 and the Health Planning and Resource Development Act of 1974 were widely criticized for their inability to control costs effectively or to increase the efficiency of health services delivery. The design and implementation of the federal government's latest entry into health planning, the Trauma Care System Planning and Development Act of 1990 (Pub. L. 101-590), suggests that federal and state officials are poised to repeat the mistakes that plagued previous planning programs. The implementation of Pub. L. 101-590 illustrates the dilemmas that federal and state officials must confront in achieving effective representation and ensuring active participation in the planning process. Successful regional and statewide planning ventures must devise strategies to overcome the inherent collective action problems associated with cooperative solutions to underserved populations. Contemporary approaches to health planning, however, are based on a number of questionable assumptions. The creation of new institutional structures merely shifts the venue for existing conflicts among health providers, third-party insurers, and other participants in the health policymaking process to a new arena. In addition to examining possible alternatives for improving current trauma system planning initiatives, this paper presents a new paradigm for designing and implementing state and federal planning programs.

Emergency Medical Services↗
PubMed1993

New wine in old bottles: certificate of need enters the 1990s.

Although state certificate-of-need (CON) programs have been the subject of intense criticism over the past decade, recent evidence suggests that CON programs may be more effective than commonly believed. While many state programs have yielded disappointing results, the CON process can also be used to achieve other important policy objectives, such as increasing access to care for the uninsured and increasing lay participation in health policy planning. In sum, rather than fading away after the termination of federal support for health planning in 1986, state CON programs are poised to assume new roles during the 1990s.

Certificate of Need↗